Title: Spine Letter

Category: Digest of current information and literature on the spine.

Publisher: J.B. Lippincott Company

Cost: $95 (US)

This review is based on a reading of the March, June, and August
samplings of the Spine Letter.

It appears that this newsletter has been designed to disseminate
current issues relative to the spine that do not have a place in
Spine (the journal) or are time sensitive. Like Spine, which from a
chiropractic point of view may contain absolutely nothing relevant
in one issue and an abundance in the next, the newsletter appears
to follow the same direction.

Taking one issue as an example, June l994, the following was
relevant to chiropractic.

This is a well written, and for the most part, an unbiased report
of 8,000 people surveyed for low back pain over two years. An
abridged version of some of the findings:

similar outcomes for MDs and DCs;

DCs preferred to MDs;

DCs use more radiographs, have more visits;

disability, not pain, predicts the outcome, a concept
that until this study was always thought to be the
reverse.

This study is ongoing. The Spine Letter will publish new
information as it is available. (For more information on the study,
see "Chiropractic Treats 33% of Back Pain Patients, Study Says,"
Sept. 12, 1994 issue of "DC.")

The Manga Report

This is a review of the report from the medical point of view, and
so it should come as no surprise that the report is criticized. The
Manga report is just that: a report of findings that in no way
interferes in the way the medical profession practices. The reason
the report was commissioned is always lost in the minds of those
who review it. Personal paranoia and an ego-driven limbic system
echo throughout this review. I wonder if it was actually read from
start to finish, as the big picture was missed.

SpineScope: People in the News

This is an enlightening section containing new information about a
diverse range of topics. The June issue featured data about Dr.
David Cassidy receiving, along with Dr. K. Yong-Hing, a
one-million dollar grant for a five_ year study of whiplash
injuries (see "Million Dollar Canadian Whiplash Grant," Feb. 25,
1994, "DC").

The remainder of the Spine Letter was in a medical model, although
reading this material is often revealing when you come across
statements like this from Dr. Keller of the state of Maine: "... we
also need equally urgently better information about the risks,
benefits, and outcomes of spinal surgery."

The task of trying to remain apolitical or at best transpolitical
is indeed a formidable challenge. The Spine Letter is trying to do
just that and in its short history has made a valiant effort.
Although I was extremely disappointed with the crass treatment
given the Manga report, I have not been where the MDs have been nor
have I experienced their frustrations which, like ours, must be
monstrous. I have subscribed to Spine for over 20 years and look
forward to the Spine Letter becoming similar in quality and
quantity.

Rating: a solid 9 out of 10.

Title: Chiropractic: A Review of Current Research
Category: Patient education
Publisher: Foundation for Chiropractic Education and Research
(FCER), 1-800-622-6309
Publication: Paperback, 10 pages

Ten pages may not seem like much, but it is the perfect size for a
booklet of sound bites on the effectiveness of chiropractic. It
can be read quickly by patients in the reception room of your
office, by company decision makers you are contacting about who to
send injured workers to for care, by PI attorneys, or anyone you
need to quickly impress.

Page one cites David M. Eddy, MD, PhD, who said only about 15
percent of all medical interventions are supported by solid
scientific evidence. This is followed by reviews of 12 studies,
starting with the RAND study.

What follows is the British Medical Journal study (June 1990) which
stated chiropractic confers worthwhile, long-term benefits in
comparison to hospital outpatient management. The British Medical
Journal study (March 1992) compared chiropractic, physiotherapy,
MD, and placebo. Chiropractic come out on top followed by
physiotherapy; both were better than MDs and placebo.

A review of literature done for the Department of Defense is cited
which is favorable to chiropractic, as is an article in the Annals
of Internal Medicine.

The cost-effectiveness of chiropractic care is addressed in the
second half of the booklet. A study in the Chiropractic Journal of
Australia (June 1992) concluded that workers who went to
chiropractors required fewer days off, cost the carriers less per
claim, and fewer patients became chronic compared to medical
management.

The Journal of Occupational Medicine (August 1991) examined cost
comparisons between medical and chiropractic providers for
back-related injuries with identical diagnostic codes. It
concluded that compensation costs for work time lost were only
$68.38 for patients who received chiropractic care; those who
received standard, nonsurgical medical treatment averaged $668.39.
The number of work days lost was nearly 10 times higher for those
receiving medical care.

A study by FCER in 1988 looked at the duration of temporary total
disability (TTD) in 10,652 Florida cases and found that TTD was
51.3 shorter; the total cost of care was 58.8 percent lower for
chiropractic patients compared to medical patients. Two other
studies are detailed related to cost-effectiveness.

Patient satisfaction is the next major issue in the booklet. A
nationwide Gallup poll finds that "Nine of 10 chiropractic users
felt their treatment was effective ... Eight of 10 chiropractic
users were satisfied with the treatment received and they felt that
most of their expectations were met." The Western Journal of
Medicine (March 1989) stated that chiropractic patients were three
times more satisfied with their care than patients of family
practice physicians.

Well, there it is. A professional-looking booklet that toots our
horn loudly and can be read in five minutes or less. It can be
purchased from FCER at (800) 622-6309 or (515) 282-7118 (this is
booklet #9222). If anyone at FCER is reading this, I would
recommend for future printings that each study be given its own
page(s) to make the presentation a little cleaner and the cover be
jazzed up a little. For the rest of you, don't hold these
criticisms against the book. Buy dozens of them and spread the
word.